Gangi Devon N, Corona Laura, Wagner Liliana, Weitlauf Amy, Warren Zachary, Ozonoff Sally
Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California-Davis, Sacramento, CA; and.
Department of Pediatrics, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Vanderbilt University Medical Center, Nashville, TN.
J Dev Behav Pediatr. 2025 Jun 17;46(3):e261-e268. doi: 10.1097/DBP.0000000000001358.
This study focused on in-home use of a tele-assessment tool for autism diagnosis in young children, the TELE-ASD-PEDS (TAP). Psychometric properties, caregiver experiences, and perceptions of feasibility were examined among families likely to experience barriers to in-person evaluation.
One hundred eighty-two children between 18 and 42 months of age were recruited because of positive screening, primary care concerns, or early intervention referral. All participants completed initial tele-assessment including the TAP. Approximately 2 weeks later, a second visit was conducted: 92 were randomized to a repeat TAP administration by telehealth and 90 were randomized to an in-person evaluation. Caregivers completed surveys regarding challenges with technology and satisfaction with telehealth assessment.
Overall, 77% of the sample was diagnosed with autism spectrum disorder (n = 140). There were few diagnostic disagreements (n = 10, 6%) between initial and second evaluations, with disagreements equally distributed between second visit type. Diagnostic outcomes (autism vs no autism) agreed between telehealth and in-person evaluation for 94% of cases, kappa = 0.82. Outcomes agreed between 2 telehealth visits for 94% of cases, kappa = 0.84. Test-retest reliability of total TAP scores across 2 administrations was strong, intraclass correlation coefficient = 0.85. Very few caregivers reported challenges with technology during telehealth appointments (<6%); 92% reported that there was nothing they would change about the telehealth visit. Examiners also reported high satisfaction with telehealth assessments.
In-home use of the TAP is valid, reliable, feasible, and acceptable to caregivers. Findings support the continued use of telehealth assessment for autism in toddlers, which can reduce disparities in access to timely diagnostic services.
本研究聚焦于一种用于幼儿自闭症诊断的远程评估工具——远程自闭症儿科评估工具（TELE-ASD-PEDS，简称TAP）的家庭使用情况。研究考察了可能在进行面对面评估时遇到障碍的家庭中该工具的心理测量特性、照料者的体验以及对可行性的看法。
招募了182名年龄在18至42个月之间的儿童，这些儿童因筛查呈阳性、初级保健方面的担忧或早期干预转诊而来。所有参与者均完成了包括TAP在内的初始远程评估。大约2周后，进行了第二次访视：92名儿童被随机分配接受通过远程医疗重复进行的TAP评估，90名儿童被随机分配接受面对面评估。照料者完成了关于技术挑战和对远程医疗评估满意度的调查。
总体而言，77%的样本被诊断为自闭症谱系障碍（n = 140）。初次评估和第二次评估之间几乎没有诊断分歧（n = 10，6%），分歧在第二次访视类型之间平均分布。在94%的病例中，远程医疗评估和面对面评估的诊断结果（自闭症与非自闭症）一致，kappa值 = 0.82。在94%的病例中，两次远程医疗访视的结果一致，kappa值 = 0.84。两次评估中TAP总分的重测信度很强，组内相关系数 = 0.85。在远程医疗预约期间，极少有照料者报告遇到技术挑战（<6%）；92%的照料者表示他们对远程医疗访视没有任何想要改变的地方。检查者也对远程医疗评估表示高度满意。
在家中使用TAP是有效、可靠、可行且照料者可接受的。研究结果支持继续将远程医疗评估用于幼儿自闭症诊断，这可以减少在获得及时诊断服务方面的差距。
